缺血后处理对急性心肌梗死患者血浆脑钠肽影响及意义

目的探讨缺血后处理对急性心肌梗死(AMI)患者血浆脑钠肽(BNP)影响及其临床意义。方法根据急诊经皮冠状动脉腔内介入治疗术(PCI)设置心肌梗死后处理方式,将101例急性ST段抬高型心肌梗死患者分为2组:缺血后处理组(46例)和常规PCI组(55例),比较2组术后2 h、6 h、12 h、24 h、2 d、4 d及7 d血浆BNP值及术后2周左心室射血分数(LVEF)、舒张末期容积指数(LVEDVI)、收缩末期容积指数(LVESVI)和局部室壁运动指数(RWMI),比较2组术后30 d内心脏事件的发生率。结果与常规PCI组比较,缺血后处理组血浆BNP水平在术后2 d(270.3±82.4)ng/L vs(315.4±90.6)ng/L,P0.05]、4 d(370.7±89.5)ng/L vs(419.5±94.1)ng/L,P0.01]及7 d(120.2±43.5)ng/L vs(178.6±54.8)ng/L,P0.01]低,术后2周LVEF高(50.6±4.2)%vs(47.5±5.3)%,P0.01],LVESVI(31.3±5.1)ml/m2 vs(35.7±7.2)ml/m2,P0.01]、LVEDVI(57.5±5.3)ml/m2vs(61.8±5.9)ml/m2,P0.01]及RWMI(1.51±0.46)vs(1.73±0.52),P0.05]低。术后30 d内缺血后处理组心脏并发症总发生率明显低于常规PCI组(P0.05)。结论缺血后处理降低急性ST段抬高型心肌梗死患者PCI术后2 d、4 d、7 d血浆BNP水平,改善患者心功能、心室重构和预后。

Influence and significance of brain natriuretic peptide in ischemic postconditioning after acute myocardial infarction

Objective To explore the effect of ischemic postconditioning on brain natriuretic peptide（BNP） after acute myocardial infarction（AMI） and its clinical significance. Methods One hundred and one patients of AMI treated with emergency percutaneous coronary intervention（PCI） were divided into ischemic postconditioning group（n = 46） and conventional PCI group（n = 55） according to whether they were given ischemic postconditioning way. The sera BNP concentration at 2 h,6 h,12 h,24 h,2 d, 4 d and 7 d after the PCI were compared respectively,and left ventricular ejection fraction（LVEF）,left ventricular end-diastolic volume index（LVEDVI）,left ventricular end-systolic volume index（LVESVI）,region wall movement index（RWMI） after the PCI for 2 weeks,and occurrence rate of cardiac events after the PCI for 30 days were compared between two groups. Results Compared with conventional PCI group,BNP concentration decreased （270.3 ± 82.4） ng/L vs（315.4 ± 90.6） ng/L,P〈0.05] at 2 d,（370.7 ± 89.5） ng/L vs（419.5 ± 94.1） ng/L,P〈0.01] at 4 d,（120.2 ± 43.5） ng/L vs（178.6 ± 54.8） ng/L,P〈0.01] at 7 d after the PCI in ischemic postconditioning group,respectively. After the operation for 2 weeks,LVEF increased （50.6 ± 4.2）% vs（47.5 ± 5.3）%,P〈0.01], LVESVI （31.3 ± 5.1） ml/m^2vs（35.7 ± 7.2） ml/m^2,P〈0.01] and LVEDVI （57.5 ± 5.3） ml/m^2vs（61.8 ± 5.9） ml/m^2,P〈0.01] and RWMI （1.51 ± 0.46） vs（1.73 ± 0.52）,P〈0.05] decreased in ischemic postconditioning group than those in conventional PCI group. After the operation for 30 days,the occurrence rate of cardiac events was significantly lower in group than that in conventional PCI group（P〈0.05）. Conclusion Ischemic postconditioning can decrease the serum BNP concentration at 2,4,7 d after the PCI and improve cardiac function,left ventricular remodeling and prognosis in acute ST-segment elevated myocardial infarction.